A 24-year-old man developed severe chronic
conjunctivitis in his left eye, which resulted
in minor symblephara and dry eye after 10
months. One year later, the patient developed
recurrent bloody tears in his left eye and several
hematomas in the left periorbital region. Even
after extensive workup, local causes or a
systemic condition could not be determined.

Imagine you are a doctor handling this case, what would you do when
you can’t seem to find the root cause of why this man bleeds from his
left eye? What is the best treatment for his condition? What would
your decision processes be? When faced with mysteries in life, the
inquiring mind naturally asks questions. Constructing good clinical
questions is one of the first steps in practising Evidence-Based
Medicine (EBM).
The most commonly cited definition of Evidence-Based Medicine
(EBM) comes from Dr David Sackett (1996) where EBM is “the
conscientious, explicit and judicious use of current best evidence in
making decisions about the care of the individual patient. It means
integrating individual clinical expertise with the best available external
clinical evidence from systematic research.”
The integration of the above three components into clinical decisions
enhances the opportunity for optimal clinical outcomes to ensure the
patient gets the best possible care.

What is Evidence-Based Medicine?

Clinical
Judgement

Relevant
Scientific
Evidence

One of the steps in practising EBM requires the medical practitioner
to systematically search the best medical literature available. In Lee
Kong Chian School of Medicine, medical students are taught how to
search for medical literature. The Medical Library provides access to
the highest quality medical literature through three sources:
OVID, a platform which provides seamless searching on Medline,
EMBASE, EBM Reviews (Cochrane Collaboration) databases, fulltext medical journals and e-books.
ClinicalKey, a clinical insight search engine, draws evidence-based
information from more than 900 textbooks, 500 medical journals, and
more than 9,000 videos.
UpToDate is an evidence-based clinical decision support resource,
enabling medical practitioners to make the right decisions at the point
of care. Integrated with VisualDx, a medical image database that
has 30,000 high-quality peer-reviewed medical images spanning
diseases of the skin, nails, hair, oral mucosa, genital mucosa, eyes,
and lungs as well as other internal and systemic diseases to assist in
visual diagnosis.
Medical librarians can guide students and practitioners on the
usage of these databases by teaching them search strategies and
evaluation skills. This will enable them to apply these steps in the
EBM framework:
Critical appraisal which involves testing evidence for validity, clinical
relevance, and applicability (usefulness in clinical practice)
Making a decision – applying the results in practice taking into
account patients’ preferences and
Evaluating
decisions

performance

through

auditing

evidence-based

Applying the steps above, our medical students and practitioners
will discover through the medical literature found in the databases
recommended in this article, that after eliminating all possible causes,
a treatment for the man with bleeding eyes would be the administration
of vitamin C 1000 mg daily to promote vascular stabilization. In some
cases, it was reported that the bleeding lessens and stops completely
with no intervention. With such evidence from the literature, medical
practitioners can discuss the choice of treatment with their patients
who suffer from bloody tears.